Urgent Topics in Infectious Disease In Indonesia

DR.Dr.Zinatul Hayati M.Kes Sp.MK Haris Munirwan

Gottigen University, Germany, March 02 ,2009

Subject Matter

1. 2. 3. 4. 5. 6. 7. 8.

Introduction
Profile of Indonesia

Urgent Topics in Infectious Disease in Indonesia

Malaria Pulmonary Tuberculosis Dengue Haemorrhagic Fever (DHF) Diarrhea Avian Influenza Acute Respiratory Infection (ARI) HIV/AIDS Chikungunya

Introduction
Indonesia:
is the largest archipelago in the world a country that have 222.05 million total populated that have nearly 17000 islands. have population below national poverty line at 17% of population

Indonesia major health problems

Infectious diseases exacerbated by malnutrition particularly TB & malaria

Under-nutrition in children remians high

Non communicable diseases are emerging as a major threat

Ten Most Diseases of Inpatient in Hospital 2005 In Indonesia

No. 1 2 3 4 5 6 7 8 9 10 Disease Diarrhea and gastroenteritis caused by certain infection (Colitis Infection) Typhoid and paratyphoid fever Dengue Haemorrhagic Fever (DHF) Other complications of pregnancy and delivery Intracranial injury Transportation accident Fever or unknown origin Other specified, unsoecified and multiple injuries Malaria (includes all malaria) Pneumonia
Source: Depkes RI

Ten Most Lethal Diseases in Hospital in Indonesia 2007

5000 4500 4000 3500 3000 2500 2000 1500 1000 500 0
S tr

De t c se 4377 3677 2716 2578 2539 2521 2519 2459 2384 2223 De t c se

, ,, ,
ke tr o cr t ter p c ee sc e us re fp so rt ce c e r ve ce pt Se e ur F Re I tr cr D ue De P ur eu es et H e o e s tu r or DM ID c ) HF (D

er ev F

I s rr e Ot

e t ro o

to

c er

Source: Depkes RI 2008

Diarrhea Filariasis alaria

Chikungunya

Urgent Topics in Infectious Disease in Indonesia

ulmonary Tuberculosis

A ian Influenza Acute Respiratory Infection (ARI)

Dengue aemorrhagic Fe er (D F)

IV/AIDS

1.Malaria
Malaria as one of transmitted disease which is still be a community health problem, has effect in human resource quality decreasing that can cause all economy, social problem, even national safety and defense. This is despite the fact that malaria is an easily preventable and cureable disease. Situation of malaria morbidity rate in Indonesia during 2001 2007 relatively tended to decrease.

MORBIDITY SITUATION OF MALARIA 2001 2007 in IN INDONESIA

60 51,6 50 40 30 20 10 0 2000 2001 2002 2003 2004 2005 2006 2007

Source: Ditjen PPPL,Depkes RI 2008

45 40 30 25 22,5 20 17,5

MALARIA MORBIDITY SITUATION PER Malaria 1000 PEOPLE

Malaria morbidity rate had decreased to .

. per ,000 population in 2000 per ,000 population in 200 .

MORTALITY SITUATION OF MALARIA 2001 2007

5 4,9 4,5 4 3,5 3 2,7 2,69 2,5 2 1,68 1,5 1,4 0,92 1 0,45 0,56 0,5 0 20002001200220032004200520062007

% CFR of Malaria East

Source: Ditjen PPPL,Depkes RI 2008

Situation of malaria mortality rate during 2000 200 relati ely fluctuated, it was 2. % in 2000 increased to . % in 200 and then back to decrease to 0. % in 200 ; this alue was lower comparing to the indicator target that must be reached (target 0. % in 200 ),

Prevention in Indonesia
Rapid diagnosis affirmation (Active Case Detection by malaria village worker to find the people with clinical malaria sign ) Eliminate malaria with kelambu Disease vector investigation Massive treatment Malaria Counselling.

2. Pulmonary Tuberculosis
Indonesia is a tropic country that recognize among 22 high burden TB countries as decribe by the WHO The Incident case of TB per 100.000 resident in Indonesia show tendency of degradation during year range of time 2000-2006

INSIDENCE RATE OF NEW CASES OF AFB+ PER 100,000 POPULATION IN INDONESIA

140 126 120 100 80 60 40 20 0 2000 2001 2002 2003 2004 2005 2006
Source: Ditjen L, Depkes RI 2008

122

118

115

110

107

104

INSIDENCE RATE OF NEW CASES OF AFB+ PER 100,000 East POPULATION

In the year 2000 Number Incident equal to 2 per 00.000 people, this number continue to go down till reach le el 0 per 00.000 resident in the year 200

PROPORTION OF TB CASES BY TYPE 2007

AFB Positif AFB Negatif Relaps Extra Lung

Source: Ditjen

L, Depkes RI 2008

Pulmonary TB Control
Prevention and elimination Pulmonary TB are conducted by DOTS (Directly Observed Treatment Shortcource Chemotherapy) method or Pulmonary TB treatment with directly observing by Drugs Intake Supervisor. These programs cover case detection by sputum examination on health providers followed-up by treatment package. This program succed for decreasing prevalence of TB at 126/100.000 people at 2000 to 104/100.000 people at 2006

3. Dengue Haemorrhagic Fever (DHF)

Dengue Hemmorage Fever is starting to infect indonesia since year 1968. Dengue Hemorrhagic Fever (DHF) has spread to all provincial areas and the number of infected districts up to 2007 is 330 districts/municipalities (75% of district/municipality). DHF often emerges as an outbreak with relatively high morbidity and mortality rates.

INCIDENCE OF DHF, 2003 2007

80 70 60 50 40 30 20 10 0 2003 2004 2005 2006 2007

L, Depkes RI 2008 Source: Ditjen

71,78 52, 8 3, 2 37, 23,87

(PER 100,000 POPULATION)

E st

In the year 200 Number Incident equal to 2 ,8 per 00.000 people, this number is increasing unttill reach le el , 8 per 00.000 resident in the year 200

CFR (%) OF DHF, 2003 2007

, , ,2 0, 0, 0, 0,2 0 2003 200 200 200 2007
Source: Ditjen L, Depkes RI 2008

, ,3 ,2 ,0 ,0
CFR (%) OF DHF

Eas

In the year 200 CFR equal to , %, this number is decreasing untill reach le el ,0 % in the year 200

DHF Control
1) Disease and vektor surveilance 2) Rapid diagnosis affirmation and treatment 3) Vector eradication

4. Diarrhea
Diarrhea is the most disease of Inpatient on hospital in Indonesia. Diarrhea is the third death cause in Indonesia. In 2007, CFR caused by diarrhea was 1.3% with 46 deaths from 3661 cases.

Data of diarrhea 2000 2007

12000 10.980 10000 8000 6000 5.051 4000 2000 0 16 2004 12 2005 16 2006
Source: Ditjen

Outbreak Province Total Case 3.661

3.314

8 2007
L, Depkes RI 2008

In the year 200 , the outbreak pro ince at pro ince, and total case at . , but the case relati ely fluctuated. the outbreak pro ince at 8 pro ince, and total case at . at 200

Data of diarrhea 2000 2007

300 250 200 150 100 50 0 53 1,6 2004 127

277

Death Case CFR (%) 46

2,51 2,52 1,3 2005 2006 2007 Source: Ditjen

L, Depkes RI 2008

In 200 , the death case of diarrhea at case and CFR at , %. but the case case and CFR at , % in relati ely fluctuated. the death case of diarrhea at 200

5. Avian Influenza
Avian Influenza is a disease caused by A type influenza virus, includes in family Orthomyxoviridae In Indonesia, the type of avian influenza virus that very virulent strain that is subtype of A H5N1 Avian influenza (AI) first case was reported on June 2005 in Tangerang, Banten

SPREADING OF AVIAN INFLUENZA IN INDONESIA 2005-2007

Source: Ditjen

L, Depkes RI 2008

AVIAN INFLUENZA CONFIRMED DEATH CASE AND CFR IN INDONESIA 2005-2007

90 80 70 60 50 40 30 20 10 0 2005 2006 65 81,8

88,1

Case Death Case CFR %

2007

Source: Ditjen

L, Depkes RI 2008

During 200 , AI confirmed case on human was reported in Indonesia, which was 20 cases with

people dead

AI CONFIRMED CASE BY SEX 2005-2007

WOMEN 9%

MEN %

Source: Ditjen

L, Depkes RI 2008

6. Acute Respiratory Infection (ARI) ARI is the first death cause disease for infant In Indonesia (22,30% of all infant death case) ARI is the 8th death cause disease In Indonesia morbidity (2/1000) and mortality (4%)

REPORT COMPLETENESS OF UNDERFIVE PNEUMONIA DETECTION IN 2002 2006

700000 600000 641.136 625.611 600.720

549.035 502.275 500000 400000 300000 200000 100000 0 29 24 23 31 33 2002 2003 2004 2005 2006
Source: Ditjen L, Depkes RI 2008

Reported Provi ce Detected P tient

COVERAGE OF UNDERFIVE PNEUMONIA DETECTION BY PROVINCE IN 2006

7. HIV/AIDS
This reported case is still increase in Indonesia every year. Nationally, AIDS cumulative rate per 100,000 population was 2.65 From 1997-2007, the AIDS case is increasing more than 40 times. Papua is a highest prevalence of HIV/AIDS in Indonesia

7000 000 000 000

NUMBER OF NEW CASES AND CUMULATIVE OF HIV PATIENTS DETECTED FROM SOME HEALTH SERVICES 200 2007

.0 8 .2 .2 . 88

New C C C

e ve

000 2000 000 0

2 2 .90

2 2.720

8 8

87

998

200

200

200

2007
L, Depkes RI 2008

Source: Ditjen

PROPORTION OF CUMULATIVE AIDS PATIENTS BY TRANSSMISION UP TO 2007

Unknown

Source: Ditjen

L, Depkes RI, 2008

PROPORTION OF CUMULATIVE AIDS PATIENTS BY AGE GROUP UP TO 2007

roducti e age and sexual acti ity acti e

Source: Ditjen

L, Depkes RI, 2008

CASE RATE OF CUMULATIVE AIDS CASES PER 100,000 POPULATION BY PROVINCE, 2007

Source: Ditjen

L, Depkes RI, 2008

8. Chikungunya
Chikungunya fever is a communicable disease that caused by chikungunya virus with Aedes aegypti as a vector. This disease have symptom; sudden fever, pain in joint especially knee joint, bangle, hand, backbone and accompanied by rash at skin.

SPREADING OF CHIKUNGUNYA 2004 2007

At 200 there is 2. death case.

8 case of chikungunya without

9. Filariasis
Filariasis has been still be the health problem for people in Indonesia and based on result of mapping up to 2006 The cases of Filariasis had spread in 33 provinces in 377 districts/municipalities with case number reached 10,427 chronic cases In Indonesia 3 species of filarial worm i.e. Wucherecia bancrofti, Brugia malayi and Brugia timori were found

DISTRIBUTION OF CHRONIC CASE OF FILARIASIS 2002-2007

2.000 0.000 .000 6.000 4.000 2.000 0 2002 2003 2004 200 2006 2007 6.2 76.63 6.430 To a ase 0.2390.427 .473

Elimination Program of Filariasis in Indonesia

1. Mass medication to all people in endemic districts of Filariasis use DEC 6mg/kgBW combination with Albendazol 400 mg once per year during 5 years to cut off infection cycle. 2. Manual/guidelines of Filariasis clinic cases are to prevent and to minimize deformity/physical defect.